Metronidazole 2 g as a single oral dose, metronidazole 400-500 mg twice daily for five to seven days, intravaginal clindamycin cream (2%) once daily for seven days, or intravaginal metronidazole gel (0.75%) once daily for five days4 The infection often recurs and acidic vaginal jelly (such as Relact from Kora Healthcare) may reduce relapse rates27 Partner notification not needed Vulvovaginal candidiasis
Vaginal imidazole preparations (such as clotrimazole, econazole, miconazole—various preparations are available including single dose ones), or fluconazole 150 mg orally8 The role of alternative treatments like tea tree oil and yoghurt containing Lactobacillus acidophilus have not been evaluated9 Oral versus vaginal treatment depends on preference Treatment for candidiasis is available over the counter in the UK Partner notification not needed Chlamydia trachomatis
Doxycycline 100 mg twice daily for seven days (contraindicated in pregnancy), azithromycin 1 g orally in a single dose (WHO recommends azithromycin in pregnancy but the British National Formulary advises against its use unless no alternatives are available)13 A test of cure is not indicated13 Partner notification required Gonorrhoea
Cefixime 400 mg as a single oral dose or ceftriaxone 250 mg intramuscularly as a single dose16 Referral to a genitourinary medical unit is encouraged because of the existence of resistant strains of the organism16 A test of cure is not routinely indicated if an appropriately sensitive antibiotic has been given, symptoms have resolved, and there is no risk of reinfection16 Partner notification required Trichomonas vaginalis
Metronidazole 2 g orally in a single dose or metronidazole 400-500 mg twice daily for five to seven days17 Partner notification required Readers should refer to BASHH guidelines, the British National Formulary, and local policies for full treatment options, including treatment in pregnancy
Spence D and Melville C. Vaginal discharge. Clinical Review. BMJ. 2007 Dec 1; 335(7630): 1147–1151. doi: 10.1136/bmj.39378.633287.80, PMCID: PMC2099568